New guide for doctors on how to break bad news

Breaking bad news is one of the unenviable aspects of the job of being a doctor – but the sad task of telling a patient they are going to die will be performed many times in hospitals and surgeries around the country today.

Finding the right way to deliver this kind of devastating news can be mostly down to experience but individual styles differ.

It is all about doing their best in difficult circumstances. But medical schools can leave doctors ill-prepared for this role.

A new guide for all healthcare staff in hospitals and other settings gives them well researched advice on ways to try to make this news easier for a patient and for their relatives.

"Any trauma on hearing bad news should relate to the actual news and not to the manner in which it is imparted," said the guide from the Irish Hospice Foundation.

It suggests giving a "warning shot" and pause.

This could be followed by the phrase: "I'm afraid it looks rather serious."

They should avoid jargon and use simple language. Break the news in chunks and check the patient is understanding.

Acknowledge their reactions and say: "I can see this is a shock for you."

Allow for silence and tears and avoid false assurances. The doctor or other healthcare professional should have a clear plan made out in advance on what will happen next for the patient.

They should avoid saying: "There is nothing more we can do". Instead tell them that "there isn't any specific treatment to make your illness go away but there is a lot we can offer you to cope".

Patients should also be regularly offered discussions regarding their prognosis, concerns, needs and wishes at the end of life.

The patient should also be offered the option of not discussing topics and deferring the discussion to another time.

"Once a terminal diagnosis is made patients can feel abandoned. It is important to reassure the patient that you and your team will be there for them throughout their illness."

If this is not possible, it is vital that alternative arrangements are spelled out and are reliable, the guide points out.

Emphasise support by saying: "We have different ways to relieve (pain, nausea, breathlessness) and other symptoms."

It is important to encourage patients to share in the decision making and always end discussions with a follow up plan as patients may need to consider decisions or reconsider what has been discussed.

The majority of us would like to die at home but the reality is that only a quarter will have this wish fulfilled.

Nearly half will end their days in hospital with another quarter passing away in a nursing home. Around 6pc of people die in hospices.

In hospital one-in-five patients dies in critical care units, another 12pc in emergency departments and nearly seven-in-10 in a ward.

Often patients take little in when they are first given bad news but once their mind clears they should feel free to write down questions and put them to the health staff at their next visit.

Jackie Crinion, acting manager of the Hospice Friendly Hospitals programme said the care map was prompted by their work in hospitals throughout Ireland where staff need resources to deliver good care to dying patients and their families.